Control of neonatal tetanus in southern Thailand.

Abstract

Prior to 1989, Krabi and Satun, two neighbouring provinces with similar socioeconomic background and health service coverage, had the highest reported incidence rates of neonatal tetanus in Thailand (3 per 1000 livebirths). A control programme was conducted between 1989 and 1991. The objective of this study was to examine changes in prevalence of risk factors among the population and changes in incidence rates of this disease due to this programme. Two 30-cluster surveys to measure prevalence rates of risk factors were conducted in Krabi, before and after the campaign. Information on incidence was obtained from routine surveillance. The intervention in Krabi consisted of mass immunization and intensive education for traditional birth attendants (TBA) whereas only the latter was carried out in Satun. The incidence of neonatal tetanus in both provinces declined dramatically to less than 0.4 per 1000 livebirths in 1990 and 1991. From 1989 to 1991, in Krabi Province, the coverage of at least two doses of tetanus toxoid injections at any time prior to delivery, delivery by trained health personnel, acceptable sterile technique for umbilical cord cutting and correct method of dressing the umbilical stump rose from 70 to 88%, 55-80% cent, 80-94% and 40-74%, respectively. Reduction in the incidence rate of neonatal tetanus was achieved by strengthening of routine health services with or without additional mass immunization. Considering that the coverage of immunization has not yet been completed and the prevalence rates of different risk factors are still high, further attempts to improve the problem of neonatal tetanus are necessary.